General principles and indications

Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Gynaecological procedures and their requirement for surgical antibiotic prophylaxis for the indications for surgical prophylaxis for gynaecological procedures. For recommendations for prophylaxis for urodynamic studies, see Surgical prophylaxis for urological surgery.

Investigate patients for sexually transmitted infections (STIs):

• if they have symptoms of an STI
• before insertion of an intrauterine contraceptive device
• before a transcervical procedure, including surgical termination of pregnancy and hysteroscopy.

If the results of investigations are positive, provide appropriate treatment for the STI to reduce the risk of postprocedural infective complications; ideally, treatment should be completed before the procedure.

The benefit of routine prophylaxis for pelvic organ prolapse or stress urinary incontinence procedures has not been demonstrated in clinical trials. Despite this, it is the consensus view of the Antibiotic Expert Groups that a single dose of prophylaxis should be used for procedures involving insertion of synthetic material because mesh infection is associated with poor outcomes.

Infection following medical (pharmacological) termination of pregnancy is rare and usually related to retained products of conception; antibiotic prophylaxis is not required.

Prophylaxis against enterococcal endocarditis is indicated for patients with specific cardiac conditions (see here) who are undergoing gynaecological procedures for which surgical antibiotic prophylaxis is required, with the exception of surgical termination of pregnancy. If the surgical antibiotic prophylaxis regimen does not include an antibiotic active against enterococci (eg amoxicillin, ampicillin, vancomycin), see Endocarditis prophylaxis for genitourinary and gastrointestinal tract procedures for appropriate add-on recommendations.

For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.